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2011; American Diabetes Association; Volume: 60; Issue: Supplement_1 Linguagem: Inglês

10.2337/db11-1-378

1939-327X

Monika A. Niewczas, Vishal S. Vaidya, Linda Ficociello, Venkata Sabbisetti, James H. Warram, Joseph V. Bonventre, Andrzej S. Królewski, Michele Cavalera, Loredana Fiorentino, Stefano Menini, Marta Fabrizi, Giuseppe Pugliese, Paolo Sbraccia, Davide Lauro, Renato Lauro, Massimo Federici, James Larkin, Naila Rabbani, Daniel Zehnder, Paul J. Thornalley, Bo Seok Jeong, Inah Hwang, Jong Park, Jung-Hwa Lee, B. Lee, Toshio Miyata, Hunjoo Ha, Takeshi Matsubara, Hideharu Abe, Tatsuya Tominaga, Kou‐ichi Jishage, Akira Mima, Otoya Ueda, Makoto Araki, Kazuo Torikoshi, Kojiro Nagai, Chisato Goto, Masahiko Kinosaki, Noriyuki Iehara, Naoshi Fukushima, Atsushi Fukastu, Paul J. Beisswenger, Greg Russell, Michael Miller, Luiza Caramori, Julia Steinke, Stephen S. Rich, Michael Mauer, Limei Liu, Taishan Zheng, Feng Wang, Niansong Wang, Yanyan Song, Ming Li, Lifang Li, Jiamei Jiang, Weijing Zhao, Ming Lu, Hong Chen, Kun‐san Xiang, Weiping Jia, Christopher Brown, Adriana Giongo, Austin Davis-Richardson, K.A. Gano, David B. Crabb, Nabanita Mukherjee, George Casella, Jennifer C. Drew, Heikki Hyöty, Riitta Veijola, Tuula Simell, Olli Simell, Josef Neu, Clive Wasserfall, Desmond Schatz, Mark A. Atkinson, Eric W. Triplett,

Chemotherapy-related skin toxicity

The aim of this study was to evaluate whether urinary markers of tubular injury are predictors of early glomerular fi ltration rate (GFR) loss in diabetes.Our study group consisted of 255 Joslin subjects with type 1 diabetes, no proteinuria and normal GFR at baseline.This cohort was followed for 5-7 years and multiple determinations of serum cystatin C were performed to identify patients with signifi cant early GFR loss.As the outcome of the study rapid GFR loss during 5-7 years of follow-up was defi ned as an annual GFR decrease >4%.Baseline urinary concentrations of tubular markers, N-acetyl-b-D-glucosaminidase (NAG) and Kidney Injury Molecule-1 (KIM1) were measured by nephelometry and on the Luminex platform, respectively.Rapid GFR loss occurred in 49 subjects (20%) and was more frequent in those who had higher concentrations of KIM1 in urine, p value for trend: 0.0001.Proportion of cases stratifi ed by KIM1 increasing quartiles is presented in the table below.KIM1-Q1 KIM1-Q2 KIM1-Q3 KIM1-Q4 GFR loss [%] 8 11 27 31 number at risk 64 63 64 64Multivariate logistic analysis included baseline age, albumin excretion rate (AER), hemoglobin A1c and body mass index.Odds ratio of rapid GFR loss for subjects with KIM1 concentrations above median were OR (CI): 3.9 (1.9-7.9),p value 0.0002 in the univariate, and 2.7 (1.3-5.8),p value 0.009, in the multivariate model, respectively.Association of NAG with rapid GFR loss was borderline and did not remain signifi cant in the multivariate analysis.Urinary concentrations of KIM1, but not of NAG, predict early rapid GFR loss in subjects with type 1 diabetes.These fi ndings also provide strong evidence that tubular injury is involved in the disease process, which underlies the development of early progressive renal function loss.